Official U.S. Health Agencies Health Article

OFFICIAL U.S. HEALTH AGENCIES

The role of the U.S. government in health policies and programs has its roots in the Constitution. This role is made clear by Lawrence A. Gostin:

The Constitutional design reveals a plain intent to vest power in government at every level to protect community health and safety. By its very first sentences, the Constitution provides sole legislative or policy making authority in the Congress, and the first enumerated legislative power is to provide for the common defense and general welfare of the United States. The legislative role is to enact laws necessary to safeguard the population from harms and promote health (e.g., food and drug purity, occupational health and safety, and a healthy environment) (Gostin 2000, p.2838).

The powers granted to the federal government to regulate interstate commerce, to tax, and to spend have been the most important powers used to protect and promote the health of the population. It was not until the policies advocated by President Franklin Roosevelt in the 1930s, including Social Security, that the welfare clause was used to expand the federal role in domestic social programs. The Medicare program enacted in 1965 to finance hospitals and physicians' services for the elderly and disabled and the Medicare Program—a joint federal-state program to finance health care to certain categories of the poor—was based on the authorities granted in the original Social Security Act of 1935, which represented a fundamental shift in the role of the federal government.

While the Department of Health and Human Services is the lead federal agency on health, the United States government has health functions in over forty different departments and agencies, including the Departments of Agriculture, Veteran's Affairs, Commerce, Defense, Education, Energy, Health and Human Services, Housing and Urban Development, Interior, Justice, State, Transportation, and Treasury, as well as such independent agencies as the Consumer Product Safety Commission, the Environmental Protection Agency, the Nuclear Regulatory Commission, the National Science Foundation, and the United States International Development Corporation, which includes the U.S. Agency for International Development. (For a detailed description of the various federal department, agencies and commissions that carry out federal health functions see: G.T. Kurian, ed. [1998]. A Historical Guide to the U.S. Government. New York: Oxford University Press.)

Policies affecting public health begin with the legislative branch, which consists of the two houses of Congress (the Senate and the House of Representatives). Both the Senate and the House of Representatives affect how or if policies affecting health and environmental programs become law. Congress often determines which federal department or agency will implement these policies. Congress also plays a primary role in the funding of the federal government's public health functions. No money can be spent by a federal department or agency unless appropriated by Congress.

The states play a central role in promoting and protecting the population's health. The states have what are described as reserved powers that permit them to exercise all the powers inherent in government that are neither granted to the federal government nor prohibited to the states by the Constitution. Critical to the states' role in public health are police powers—Gostin defines police power as:

The inherent authority of the state (and, through delegation, local government) to enact laws and promulgate regulations to protect, preserve, and promote the health, safety, morals, and general welfare of the people. To achieve these communal benefits, the state retains the power to restrict, within federal and state constitutional limits, personal interests in liberty, autonomy, privacy, as well as economic interests in freedom or contract as uses of property (Gostin 2000, p. 2980).

The role assigned to the states has made the relationship of the federal government and the states in domestic social programs, including public health, critical to achieving domestic policy objectives. These roles have evolved, particularly since the expansion of the federal role during Roosevelt's New Deal in the 1930s. Federalism, which describes this relationship, traces its roots to the Latin word for covenant. To describe the formation of political society by mutually consenting individuals, the related word "compact" had been used by philosopher John Locke almost one hundred years before the ratification of the U.S. Constitution. In the United States, the ultimate arbiter of the role of the federal government and the states is the Supreme Court. Many courts, including the court as of the year 2000 have been strong defenders of the states' rights against federal domination. Other courts (e.g., the Warren Court) have defined a stronger federal role (e.g., civil rights, women's reproductive rights).

State health agencies and local departments of health are increasingly structured within the framework of federal categorical grant in aid programs for public health, environmental health, and medical care. The multiple departments and agencies at the federal level that fund public health programs are often reflected in the organization of the programs at the state and local level.